Choline: The important prenatal nutrient you might be hearing about for the first time
Reviewed by Health Guide Team,
Written by Anna Bohnengel, MS, RD, LD
last updated: Feb 26, 2021
4 min read
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Never heard of choline? You’re not alone. Prenatal nutrition has focused almost exclusively on folate (aka folic acid) for supporting fetal neural tube (brain, spine, and spinal cord) development.* However, recent research suggests that choline is equally essential in neurodevelopment, as well as for many other crucial functions.*
Juxtaposed to the increasing awareness of the importance of choline, national health data shows that 90%-95% of pregnant people in the US are not getting enough. How much is enough? According to the American College of Obstetricians (ACOG), 450 mg a day during pregnancy, and 550 mg during lactation (per the Office of Dietary Supplements). Widespread choline deficiency is partially attributable to the lagging supplement industry, as few prenatal vitamins provide choline.
If you have your sights set on having kids, it’s never too soon to start taking choline. In fact, before pregnancy is the ideal time to make sure you’ve got all the nutrients on board to encourage healthy fetal development.*
What is choline and why do you need it?
If you plan on growing a baby in your belly, that baby will rely on you to supply essential choline, one of the many B vitamins. In this section, we'll cover the biggest benefits of choline for pregnancy and birth.
1. Choline supports fetal brain development*
The American Academy of Pediatrics coined choline a "brain-building" nutrient.* In utero, the fetus relies on choline as a building block for newly forming cells in baby's brain and nervous system, for gene expression, and much more.* Much like folate, choline is an essential ingredient for the development of the spinal column (aka the neural tube).*
Choline is one of the structural components of the cell membranes, and it builds neurotransmitters for signaling in the nervous system (between neurons as well as neurons and muscles).* During fetal development, choline promotes cell proliferation in areas of the brain responsible for learning, memory, and attention.*
2. Choline helps with growth of the placenta*
During pregnancy, choline supports the placenta (the organ developed during the first trimester of pregnancy that protects the fetus, provides nutrients, and removes waste) in doing its job.* Choline forms the cell structure of this organ, promotes the formation of needed blood vessels within this new organ, and facilitates nutrient transport across the placenta to the hungry fetus.*
3. Choline may improve liver function*
Choline also facilitates fat metabolism to promote healthy liver function.*
Basically, choline's a big deal for fetal health — as well as for your health.*
Where do you get choline?
Although many foods provide some amount of choline, over 90% of adults in the US are not getting enough choline from food sources.
The best source of choline dietary intake is from beef liver. If you’re less than enthusiastic about eating liver, eggs are also a reliable source of choline. One egg yolk (note: the egg white does not provide choline) meets about one-third of your daily choline needs. If you’re a three-egg-a-day eater, you’re likely one of the few getting enough choline from food alone.
Other top dietary choline sources are beef, chicken, and fish. Although some plant-based foods (soybeans, potatoes, and brussels sprouts) provide choline, foods from animals (meat and eggs) are a much more concentrated source of choline per gram — meaning vegetarians and vegans may not be getting high enough amounts of choline from food alone. (You can see the full list of choline food sources here.)
Why do you need more choline during pregnancy?
For adults with ovaries, the recommended amount of choline is 425 mg per day. If you’re pregnant, ACOG's recommendation increases that level to 450 mg per day. During lactation (whether or not you're breastfeeding/chestfeeding), needs shoot up even higher to 550 mg per day.This is because growing another human is nutrient intensive — as that brain grows and develops in utero and postpartum, prenatal choline is required to build the brain cells and neural pathways.*
When should you start taking choline?
Critical to this conversation is the importance of taking choline prior to pregnancy. The formation of the neural tube (what will become the spinal cord and brainstem) occurs about four weeks after conception (or around 4-6 weeks after the first day of your last period) — before many even realize they’re pregnant. As pregnancy progresses, the demand for choline increases to boost brain development, support placenta function for nutrient transfer to the fetus, and ensure optimal health for the pregnant person.*
Since most of us are not getting enough choline, if there are biological kids in your future, now is the time to get this brain-building nutrient on board by supplementing your intake with a prenatal vitamin that includes choline (or a separate choline supplement).*
If choline is so important, why is it left out of many prenatal vitamins?
Before pregnancy, ACOG recommends choline along with folate, omega-3 fatty acids (DHA and EPA), vitamin C, vitamin A, vitamin B-6, vitamin B-12, iodine, calcium, and vitamin D-3 — many of which are available in prenatal vitamins.
But one 2016 study found that out of the top 25 prenatal vitamins available, only around one-third contained choline. Choline's become more common in prenatals since then, but despite its nutritional value during pregnancy, it has a long way to go before reaching folate-level pervasiveness.
There are three possible reasons for this:
Choline has only been considered an essential nutrient by the Institute of Medicine since 1998.
The American Medical Association (AMA) didn't speak out about the importance of choline during pregnancy until 2017.
It's not an easy ingredient to add to multivitamin formulations.
All of that said, if you're shopping for prenatal vitamins, look out for choline on the label — especially if you're a vegetarian or vegan and not getting enough choline from plant-based food sources.
*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
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Anna Bohnengel, MS, RD, LD
Health Guide Team
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